A possible “tripledemia” of Covid, influenza and RSV worries doctors. What there is to know

A possible convergence of influenza, RSV and Covid-19 worries doctors.

Flu cases are increasing earlier than usual, and pediatric hospitals are seeing outbreaks of respiratory syncytial virus, commonly known as RSV. There are also signs that Covid-19 cases are increasing in parts of the country as Americans head into the colder months.

Covid-19 precautions earlier in the pandemic — and their near-demise of late — are a big part of why influenza and RSV are making a comeback, doctors say. Measures such as masking and social distancing have also suppressed rates of other viruses, leaving those of us who haven’t had a recent infection with lower levels of protection now.

“It’s very clear that because people are easing Covid precautions, it’s very likely that we’ll also see an increase in flu at the same time,” says Jay Varma, director of the Cornell Center for Pandemic Prevention and Response in New York. and doctor. and epidemiologist at Weill Cornell Medicine.

All three viruses share similar symptoms, such as a cough, sore throat, runny nose and fever, making it hard to tell what you have without a test. You can test for Covid-19 at home, and most healthcare professionals can test for influenza and RSV.

Concerns ahead for Covid-19

Protection from vaccines and previous infections have significantly reduced the severity of Covid-19 infections since the start of the pandemic. However, the virus remains dangerous, especially for the elderly or those with certain health conditions. Less severe cases can still make you sick for a week or more and spread through your household, disrupting work and school. And even mild infections can cause longer-term symptoms associated with long Covid-19, such as brain fog, extreme fatigue and rapid heartbeat.

“Especially for people over 50 and immunocompromised, Covid remains a very real threat,” says Céline Gounder, senior researcher at the Kaiser Family Foundation and infectious disease specialist and epidemiologist.

The most recent data from the Centers for Disease Control and Prevention shows a decrease in the number of Covid-19 cases, hospitalizations and deaths nationwide. The 21-day average of new weekly cases was down about 31% as of October 19 from the previous 21-day rolling average. The seven-day average of hospitalizations fell 4% to 3,156, and the 21-day rolling average of new deaths fell 13% to 388.

However, it is difficult to accurately monitor Covid-19 cases because most people use rapid home tests, which usually go unreported. The CDC is also reporting Covid-19 cases less frequently, posting weekly rather than daily updates. from October. The most reliable indicator of Covid-19 cases is hospitalization data, says Dr Varma, but hospitalizations tend to lag cases by about two to three weeks.

“We think it’s the calm before the storm,” says Katelyn Jetelina, an epidemiologist who writes the popular “Your Local Epidemiologist” newsletter. “We think in November it will really start to take off nationally.”

The new Omicron sub-variants are taking over the world, with some pushes in other countries. Weekly data from the US CDC indicates that the BQ.1.1 and BQ.1 subvariants – from BA.5, the dominant subvariant of Omicron in the US – account for more than 16% of cases as of October 21, compared to 11% previously. The week before. Another subvariant, XBB, is driving a surge of cases in Singapore.

The number of cases and hospitalizations in some Western European countries are beginning to rise, which is often a harbinger of what is to come in the United States Wastewater monitoring in the Northeast also indicates that cases are starting to climb. Doctors are concerned that few people have so far received the updated version of the reminder.

The new bivalent vaccine could be the first step in the development of annual Covid shots, which could follow a process similar to that used to update flu vaccines each year. Here’s what that process looks like and why applying it to Covid might be difficult. Illustration: Ryan Trefes

Flu season starts early

At the same time, the flu is emerging earlier than usual, with the CDC citing increased activity across much of the country, particularly in southeastern and south-central states.

Rick Zimmerman, professor of family medicine at the University of Pittsburgh, has been monitoring the flu for more than a decade and says he hasn’t seen activity this early since the 2009 flu pandemic.


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Public health officials recommend that anyone 6 months and older get a flu shot ideally by the end of this month, and say it’s safe to get a flu shot and a call back Covid-19 at the same time. The dominant flu strain is an H3N2 and seems to fit well with this year’s vaccine, says Dr. Zimmerman.

“It takes about two weeks to get really good immunity after vaccination, so get your flu shot now because we’re seeing the start,” he says.

This past flu season, about half of people ages 6 months and older in the United States received the flu vaccine, according to CDC estimates. Projections are similar for this year, according to a survey by the National Foundation for Infectious Diseases.

It remains unclear whether the US flu season, while starting earlier, will be more severe in hospitalizations and deaths. It’s been a bad season in parts of the southern hemisphere like Australia, which has already had its winter, but not so bad in other parts like South Africa.

RSV rebounds

Levels of another common virus, respiratory syncytial virus, are also rising earlier than usual, filling beds in children’s hospitals.

RSV is a virus that infects the respiratory tract. Typically a mild cold in healthy people, RSV can be dangerous and even fatal in the very old and young, especially babies under 1 year old.

The only way to get immunity to RSV is through exposure because there is no vaccine, Dr. Gounder notes. RSV cases plummeted in the first year of the Covid-19 pandemic. The respiratory virus that typically circulates in the fall and winter then resurfaced in the summer of 2021. Young children who have not been exposed to the virus in recent years are now affected.

Public health experts say the same precautionary measures that protect against other respiratory viruses help prevent RSV transmission: washing hands thoroughly often, covering coughs and sneezes or wearing a mask, staying home if you are symptomatic and improve ventilation in indoor spaces.

Parents should see a doctor if a child is having difficulty breathing, gasping and wheezing, or coughing so hard they can’t breathe, says Dr. Gounder. Difficulty feeding and sinking into the soft tissues around the collarbones and between the ribs are also concerning signs.

Write to Sumathi Reddy at Sumathi.Reddy@wsj.com

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